Health insurance coverage for breast cancer care: a feminist political economy perspective on women's experiences in Ontario and New York

This thesis examines how the health insurance systems of Ontario and New York impact women's health insurance experiences in relation to breast cancer care. The analysis provided draws on insights from feminist political economy scholarship to consider the roles of states and markets as well as households and voluntary sectors in health insurance coverage. Women's experiences in Ontario-where public health insurance plays a primary role-and in New York-where private health insurance plays a primary role-are addressed against the background of welfare state transformation and neoliberal reform reaching beyond jurisdictional boundaries. Review of secondary literature, legislation and policy documents establishes the context for analysis of 42 semi-structured interviews conducted with women diagnosed with breast cancer in the neighboring jurisdictions of Lanark and Leeds Grenville in Ontario and St. Lawrence County in New York.

Thematic analysis of the interviews conducted identifies three overarching themes: 'commodified coverage', 'responsibilized individuals' and 'gradation in consequences'. With the primacy of private health insurance in New York's health insurance system, participants' narratives are found to reflect more commodified coverage, more responsibilized individuals, and greater gradation in the consequences of financing breast cancer care than in Ontario, where public health insurance plays a primary role. This thesis underlines the importance of health insurance coverage as a women's issue and highlights the importance of public policy in shaping the conditions under which women use health insurance to finance breast cancer care.